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NPI Code Detail

MEDICARE: MARY RUTAN HOSPITAL

MEDICARE: MARY RUTAN HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003875949
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY RUTAN HOSPITAL
Provider Business Mailing Address
First Line : 4879 US HIGHWAY 68 S
Second Line :
City : WEST LIBERTY
State : OH
Zip : 43357-9525
Country : US
Telephone Number : 937-599-1411
Fax Number : 937-465-9945
Provider Business Practice Location Address
First Line : 4879 US HIGHWAY 68 S
Second Line :
City : WEST LIBERTY
State : OH
Zip : 43357-9525
Country : US
Telephone Number : 937-599-1411
Fax Number : 937-465-9945
Authorized Official
Title or Position : VP/FINANCE
Name : RON CARMIN
Credential :
Telephone Number : 937-592-4015
Provider Enumeration Date : 03/20/2006
Last Update Date : 07/10/2007

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Directions to “MARY RUTAN HOSPITAL ” Practice Location

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